Presenter: Dr Joseph Gasper KimaroFacilitator: Dr Mboneko, Sen Lecturer, Department of Anatomy

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Is the name given to an area of the anterior aspect of the thigh, made up of muscles and ligaments crossings.

Is an inverted triangular shape containing medial to lateral femoral vein, artery and nerve. ‘VAN’

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Femoral vein

Femoral artery

Femoral nerve

Iliacus muscule

Pectineus muscule

Medially: medial border of the adductor longus muscle

Laterally: medial border of sartorius muscle Superiorly: the inguinal ligament

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The apex: medial border of sartorius muscle crossing medial border of the adductor longus muscle

The roof: superficial structures i.e fascia lata, cribiform fascia, subcutaneous tissue and skin

The floor: gutter shaped, formed from medial to lateral by part of adductor brevis, pectineus and iliopsoas

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1. The femoral sheath, 2. Terminal part of the femoral nerve and its

branches,3. Femoral artery and its branches,4. Femoral vein and its tributaries,5. Femoral ring,and 6. Inguinal lymph nodes

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Is a funnel-shaped fascial tube that surrounds the uppermost 4cm of the femoral vessels, a sleeve of tissue which is a continuation of fascia from within the abdomen. Ant wall is a continuation of fascia transversalis,and post wall - fascia iliaca Embryologically pulled down as the limb grew.

The mouth of the funnel opens into the abdomen behind the inguinal ligament

The lower part of the funnel gradually closes upon, and fuses with the outer coat of the vessels

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When femoral sheath opened, three compartments are seen;

1.Lateral compartment: occupied by femoral artery

2.Middle compartment: occupied to femoral vein

3.Medial compartment: also called femoral canal, filled with fat and lymph nodes, and transmit the lymphatic vessels

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Arises from the lumbar plexus (L2, 3, 4) along its course in the triangle gives branches to;

1. - the pectineus nerve 2. - the sartorius neve 3. - the anterior cutaneous nerve of the thigh 4. - the saphenous nerve

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The superior opening of femoral canal is oval shaped, called femoral ring, whose boundaries are;

- anteriorly: the inguinal ligament - posteriorly: the pectineus muscle - medially: reflected part of inguinal ligament

called lacunar ligament - laterally: femoral vein

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1. External pudendal artery2. Profunda femoris, which immediately give

two branches (a)medial circumflex femoral artery (b)lateral circumflex femoral artery

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The femoral canal, through which a femoral hernia is squeezed, is a potential weak spot in the abdominal wall.

More common in women because of wide pelvis and femoral canal

Loop of intestine, or another part of the abdominal contents (eg. omentum), can be forced out of the abdomen through the femoral canal

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The blood supply to the herniated tissue can become crushed within the canal, cutting off its source of oxygen and nutrients - strangulated hernia, which is very painful and tender to touch.

The neck of the sac is narrow, always lies below and lateral to the pubic tubercle. This distinguish it from inguinal hernia which lies above and medial to the pubic tubercle.

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being overweight (obese) having smoker's cough constipation carrying or pushing heavy loads, wt lifters subsequent pregnancy NB: All femoral hernias need to be treated

surgically as they have a high risk of becoming strangulated.

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Ca of the lower half of the anal canal may cause metastasis to the inguinal lymph nodes

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Localized dilatation lead to saphenous varix, which can be confused to a hernia, as they all increase in size when the patient is asked to cough

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Tuberculous infection of the lumber vertebrae can result in a extravasation of pus down the sheath into the thigh.

The presence of the swelling above and below the inguinal ligament with clinical sign and symptom leads to diagnosis

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Expansile swelling along the course of the femoral artery fluctuates in time with the periferal pulse rate

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Under fluoroscope view, by using contrast medium, arteries constrictions can be diagnosed e.g mesentery, kidney arteries

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Life line when peripheral veins collapse e.g hemorrhagic shock

There is a risk of - infection - pulmonary embolism

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Thank you for your attention

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